As secretary of the Department of Health and Human Services for the past two and a half years, Sylvia Mathews Burwell has overseen the Affordable Care Act, Medicare and Medicaid, the Food and Drug Administration and a wide range of social services from Head Start to family assistance programs. In a conversation with Tom Fox, Burwell discussed her concerns about impending changes to the Affordable Care Act, the presidential transition, her approach to leadership and playing basketball for President Obama's national security adviser. Fox is a guest writer for On Leadership and the vice president for leadership and innovation at the nonprofit, nonpartisan Partnership for Public Service. The conversation has been edited for length and clarity.

What are your concerns about the plans by Congress and the president-elect to repeal and replace the Affordable Care Act?

My concerns are focused on the millions of people across the country who rely on the law for coverage and for the protections it provides. It's important to note that "repeal and replace" is a campaign slogan. We need to separate this rhetoric from the reality of the Affordable Care Act. Today, more than 20 million people have health insurance who didn't have it before; no one can be discriminated against based on a pre-existing condition, and restrictions like lifetime and annual coverage limits are a thing of the past. Americans don't want to go backward, back to a world where women can be charged more for health insurance because of their gender or entrepreneurs have to choose between starting a business venture and staying in a job just to keep a health insurance plan. We can make fixes to the ACA without jeopardizing the health coverage of millions of Americans.

How are you addressing this issue with the career employees at HHS who have been involved in implementing the ACA?

We remain committed to a smooth transition of power to the next administration, and we are working with the transition team on that effort now. I have expressed great appreciation to the hard-working staff at HHS, and in the days remaining for this administration, I have instructed my team to keep working to finish strong and continue to ensure that every American has access to quality, affordable health care.